Every day I experience life in the world of healthcare IT, supporting 3000 doctors, 18000 faculty, and 3 million patients. In this blog I record my experiences with infrastructure, applications, policies, management, and governance as well as muse on such topics such as reducing our carbon footprint, standardizing data in healthcare, and living life to its fullest.

Monday, April 12, 2010

The Harvard SHARP Grant

Last week, ONC awarded $60 million to four institutions - Mayo Clinic, Harvard University, University of Texas Health Science Center at Houston and University of Illinois at Urbana-Champaign - through the Strategic Health IT Advanced Research Projects (SHARP) program.

Each institution's research projects will identify short-term and long-term solutions to address key challenges, including ensuring the security of health IT (University of Illinois at Urbana-Champaign), enabling patient-centered cognitive support for clinicians (The University of Texas Health Science Center at Houston), making progress toward new health care application and network-platform architectures (Harvard University), and promoting the secondary use of EHR data while maintaining privacy and security (Mayo Clinic of Medicine).

Many of my readers have asked for details about the Harvard grant.

It's led by Zak Kohane and Ken Mandl of the Children’s Hospital Informatics Program (CHIP) and Harvard Medical School, and includes many collaborators such as Griffin Weber MD/Phd in my HMS IT group.

They will investigate, evaluate, and prototype approaches to achieving an “iPhone-like” health information technology platform model, as was first described by Mandl and Kohane in a March 2009 Perspectives article in The New England Journal of Medicine.

The platform architecture, described as a “SMArt” (Substitutable Medical Applications, reusable technologies) architecture, will provide core services and support extensively networked data from across the health system, as well as facilitate substitutable applications – enabling the equivalent of the iTunes App Store for health.

This new approach to a health information infrastructure was the focus of a June 2009 working group meeting at the Harvard Medical School Center for Biomedical Informatics and an October HIT meeting which brought together more than 100 key stakeholders across academia, government and industry in an exploration of innovative ways to transform the national health IT system.

The SMArt platform will provide a common interface to the “App Store” for the Indivo open source personally controlled health record platform developed by the CHIP team more than a decade ago, as well as open source platforms created by other subcontractors on the ONC grant: Partners HealthCare System’s i2b2 analytic platform and the Regenstrief Institute’s CareWeb EHR.

Over the past year, much has been said about modular approaches to EHRs. Now the Certification NPRM includes that concept. One problem with the modular approach is lack of data exchange and workflow integration between modules. Zak, Ken and team will work hard, via the SHARP grant, to solve that problem.

Knowing and having worked with Ken and Zak a bit a number of years ago, I am sure this would not be that closed. On of their other major projects is an open source project, after all (Guardian Angel / PING).

My thoughts were going the way of Dude's but in a different way: will these "apps" be allowed on iPhone/iPads, or will they need to be relicensed through the iStore to reach those products? This article makes some points about the new iPhone user agreement, which could apply to this situation (http://erickerr.com/iphone-agreement-thirdparty).

Interesting. Many people reading about the SHARP grant seem confused with the metaphor of the iphone and app store. The Harvard SHARP grant has nothing to do with integrating with Apple hardware and software products. It is the conceptual model that matters.

EHR tools like Cerner, Epic, McKesson have been monolithic closed architectures and not open to modular additions like "an application for pediatric ICUs". This leads to challenges with the whole business model of healthcare IT where you make one choice and you are stuck with their stack for all medical specialties and functions.

With frameworks like i2b2 and Indivo that are already open source plus a new open EMR in the mix there is the potential to have a marketplace mixing vendors of modular components and open source applications with plug-ins for a central application for the EMR, PHR, and research data repository cores.

Hi John, Quite interesting. It is great to see the idea of a platform (preferably an open one) taking off. So far we have watched all the monolithic approaches fail in delivering a scalable solution in both vertical and horizontal directions. I have to admit though, it always surprises me to see more examples of an even bigger failure: failure to leverage joint work. What you have described with SMArt has been a goal of many projects, some open, some commercial. In fact, we are running another one in University College London, CHIME, using openEHR. It is very young, and much, much smaller in budget, but I have no doubt more collaboration, or at least more awareness would help everyone, though it usually ends up only as wishful thinking. I would be delighted to follow progress on SMArt,as well as discussing with the people involved, about what we have been trying to do. http://www.openehr.org and http://opereffa.chime.ucl.ac.uk would help the curious.

I think this is certainly the right path from the current closed systems dead ends. I would encourage Ken and Zak to think about the use of EHR's to also being one of mashups, and not exclusively as application level resuable components, but also as data pulled/pushed from federated data silos and presented as mashups. There has been a much work in this area with the developmenet of Digital Libraries for scholarly research publications. They have also used Digital Object Identifiers (DOI's)as record locator service. The DOI site states: "The Digital Object Identifier (DOI®) System is for identifying content objects in the digital environment. DOI® names are assigned to any entity for use on digital networks. They are used to provide current information, including where they (or information about them) can be found on the Internet. Information about a digital object may change over time, including where to find it, but its DOI name will not change. The DOI System provides a framework for persistent identification, managing intellectual content, managing metadata, linking customers with content suppliers, facilitating electronic commerce, and enabling automated management of media. DOI names can be used for any form of management of any data, whether commercial or non-commercial." Here is the URL on their fact sheet: http://www.doi.org/factsheets/ManagingDataRelationships.html Emanuel Mkrtichian